The purpose of this study was to evaluate the predictors of clinical outcomes after proximal hamstring repairs.
Proximal hamstring avulsions cause considerable morbidity. Operative repair often results in improved pain, function, and patient satisfaction; however, outcomes remain variable. The purpose of this study was to evaluate the predictors of clinical outcomes after proximal hamstring repairs.
We retrospectively reviewed proximal hamstring avulsions repaired between January 2014 and June 2017, with at least one-year follow-up. Independent variables included: patient demographics, medical comorbidities, tear characteristics, and repair technique. Primary outcome measures were the Single Assessment Numerical Evaluation (SANE), International Hip Outcome Tool (iHOT-12), and the Kerlan-Jobe Orthopaedic Clinic (KJOC) Athletic Hip Score. Secondary outcome measures included satisfaction, visual analog scale (VAS), and level and timing of return to running or sports.
Of 102 proximal hamstring repairs, 86 were eligible, 58 were analyzed (67%), and functional outcomes were available for 45 (52%), with 29-month mean follow-up. Average age was 51 years and 57% were female. Acute tears accounted for 66%; 78% were complete avulsions. Open repair was performed on 90%. Overall satisfaction was 94%, though runners were less satisfied (p=0.029). At 7.6 months on average, 88% returned to sports, 72% at the same level. Runners returned at 6.3 months on average, but to the same level 50% of the time, and at a decreased number of miles (15.7 vs. 7.8, p<0.001). Post-operatively, 78% had good/excellent SANE scores, but mean Tegner decreased (5.5 to 5.1). Acute repairs had higher SANE Activity scores. Mean iHOT-12 and KJOC scores were 99 and 77, respectively. Endoscopic repairs had equivalent outcomes to open repairs. In those over 50 years there was higher satisfaction (p=0.024), though lower return to running (p=0.010).
Overall, patient satisfaction and functionality were high. There were no significant differences in functional outcome scores based on age, sex, body-mass index, smoking status, medical comorbidities, tear grade, activity level, or open versus endoscopic technique. Acute repairs had better SANE Activity scores. Runners should be cautioned that they may be unable to return to the same pre-injury activity level following proximal hamstring repair.